Abstract

Volume.120 Number.1

Original article : Clinical science

Multicenter Prospective Observational Study of Fungal Keratitis -Current Status of Patients' Background, Clinical Findings, Treatment and Prognosis-
Yoshitsugu Inoue1, Yuichi Ohashi2, Takashi Suzuki2, Yoshikazu Shimomura3, Masahiko Fukuda3, Chie Sotozono4, Hiroshi Hatano5, Hiroshi Eguchi6, Kaoru Araki-Sasaki7, Saichi Hoshi8, Atsuko Sunada9, Seishi Asari9, Takashi Yaguchi10, Koichi Makimura11, Shunji Yokokura12, Kiyofumi Mochizuki13, Yu Monden14, Ryohei Nejima15; Multicenter Study Group of Fungal Keratitis in Japan
1 Division of Ophthalmology and Visual Science, Faculty of Medicine, Tottori University
2 Department of Ophthalmology, Ehime University Graduate School of Medicine
3 Department of Ophthalmology, Kinki University Faculty of Medicine
4 Department of Ophthalmology, Kyoto Prefectural University of Medicine
5 Hatano Eye Clinic
6 Department of Ophthalmology, Institute of Health Biosciences, the University of Tokushima Graduate School
7 Ideta Eye Hospital
8 Department of Ophthalmology, Fujieda Municipal General Hospital
9 Department of Medical Technology, Osaka University Hospital
10 Medical Mycology Research Center, Chiba University
11 Institute of Medical Mycology, Teikyo University
12 Department of Ophthalmology, Tohoku University Graduate School of Medicine
13 Department of Ophthalmology, Gifu University Graduate School of Medicine
14 Department of Ophthalmology, Kurume University School of Medicine
15 Miyata Eye Hospital

Purpose: To investigate the current status of fungal keratitis in Japan.
Methods: The patients with fungal keratitis were examined at 27 facilities in Japan from November 1st 2011 to October 31st 2013, concerning isolates, patient background, clinical findings, treatment and prognosis.
Results: Out of 139 cases, 133 were diagnosed as fungal keratitis, of which fungi were isolated from 72 samples of 71 cases (yeast-like fungi 32 strains and filamentous fungi 40 strains). The corrected visual acuity at the first visit of 88 cases (66.2%) was less than 20/200 and 42 cases (31.6%) were involved with deep stromal lesions, indicating high proportion of severe cases in this study. Three months later, 56 cases (42.1%) were still under treatment, and corrected visual acuity of 57 cases (42.9%) was less than 20/200. In cases with yeast-like fungi, there were significantly more cases with past history of corneal diseases, ocular surgery including keratoplasty, and eye drops' use such as steroids than those with filamentous fungi. On the other hand, there were significantly more cases of filamentous fungi, with trauma on the onset and with intervention of previously attending doctors than those with yeast-like fungi. Logistic regression analyses revealed that contact lens wearing was a significant factor of good prognosis, and yeast-like fungi as one of poor outcome compared with no fungal isolation.
Conclusion: Although the choice of antifungal drugs has been increasing, fungal keratitis is still severe, refractory and vision-threatening disease.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 120: 5-16, 2016.

Key words
Fungal keratitis, Yeast-like fungi, Filamentous fungi, Multicenter study, Logistic regression analysis
Reprint requests to
Yoshitsugu Inoue, M.D., Ph.D. Division of Ophthalmology, Faculty of Medicine, Tottori University. 36-1 Nishi-cho, Yonago-shi 683-8504, Japan